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Cardiac surgery
Original research
Surgical Complexity and Outcome of Patients Undergoing Re-do Aortic Valve Surgery
  1. Renata Greco1,
  2. Mirko Muretti1,
  3. Jasmina Djordjevic1,
  4. Xu Yu Jin2,3,
  5. Elaine Hill4,
  6. Maurizio Renna4 and
  7. Mario Petrou5
  1. 1Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Department of Cardiac Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Nulfield Division of Clinical Lab Sciences, Oxford University, Oxford, UK
  4. 4Department of Cardiothoracic Anaesthesia, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  5. 5Department of Cardiothoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  1. Correspondence to Mr Mario Petrou; M.Petrou{at}rbht.nhs.uk

Abstract

Objectives Re-do aortic valve surgery carries a higher mortality and morbidity compared with first time aortic valve replacement (AVR) and often requires concomitant complex procedures. Transcatheter aortic valve replacement (TAVR) is an option for selective patients. The aim of this study is to present our experience with re-do aortic valve procedures and give an insight into the characteristics of these patients and their outcomes.

Methods Retrospective review of 80 consecutive re-do aortic valve procedures.

Results Mean patients’ age was 51.80±18.73 years. Aortic regurgitation (AR) was present in 51 (65.4%) patients and aortic stenosis (AS) in 38 (48.7%). Indications for reoperation were: infective endocarditis (IE) (23.8%), bioprosthetic degeneration (12.5%), mechanical valve dysfunction (5%), paravalvular leak (6.2%), patient–prosthesis mismatch (3.8%), native valve disease (25%), aortic aneurysm, pseudoaneurysm and dissection (35%), aortic root/homograft degeneration (27.5%). Forty-one (51.2%) patients underwent re-do AVR, 39 (48.8%) re-do complex aortic valve surgery (28 root, 23 ascending aorta and 6 hemiarch procedures) and 37.5% concomitant procedures. A bioprosthesis was implanted in 43.8%, a mechanical valve in 37.5%, a composite graft in 2.5%, a Biovalsalva graft in 6.2% and a homograft in 10% of patients. In-hospital mortality was 3.8% and incidence of major complications was low.

Conclusions A significant proportion of patients were young (61%<60 y), required complex aortic procedures (49%) or presented with contraindications for TAVR (mechanical valve, AR, IE, proximal aortic disease, need for concomitant surgery). Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptable mortality and morbidity in a specialised aortic centre.

  • re-do surgery
  • aortic valve replacement (AVR)
  • aortic surgery
  • Trans-catheter aortic valve replacement (TAVR)
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001209

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    Footnotes

    • Contributors RG: research design, acquisition of data, interpretation of data; statistics; drafting the paper; revising the paper critically; approval of the submitted version. MM: research design; interpretation of data; drafting the paper; revising the paper critically; approval of the submitted version. JD: acquisition of data; revising the paper critically; approval of the submitted version. XYJ, EH and MR: interpretation of data; revising the paper critically; approval of the submitted version. MP: research design; interpretation of data; statistics; drafting the paper; revising the paper critically; approval of the submitted version. All the authors express their agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. All data relevant to the study are included in the article.